Spectrum and Frequency of Critical Procedures Performed at a Level I Adult and Pediatric Trauma Center
Ashley M. Strobel, MD1; Rebecca L. Kornas, MD2; Stephen W. Smith, MD1; Erik Fagerstrom, BS3; Audrey Hendrickson, MPH, CCRP3; Brian Driver, MD, Directory of Clinical Research1; Jean Tersteeg, RN4
1University of Minnesota Medical School and Hennepin County Medical Center, Minneapolis, MN; 2Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; 3Hennepin County Medical Center, Minneapolis, MN; 4Hennepin County Medical Center, MInneapolis, MN
Background: To describe the spectrum and frequency of critical procedures (CPs) at a level I adult and pediatric trauma center, and compare that to previously published data by Mittaga et al at a similar volume pediatric-only trauma center.
Methods: From February through December 2015, we conducted a prospective observational study of CPs in the emergency department (ED) at a high volume, urban, level I adult/pediatric trauma center with 96,000 annual visits. Trained research assistants (RAs) recorded all a priori determined CPs performed in our critical care area using standardized data collection forms.
Results: In eleven months, there were 4,408 ED resuscitations. RAs collected data on 3,889 (88.2%) of these cases:. 1,505 were trauma, 2,384 medical, 207 (5.3%) pediatric and 3,682 adult. There were 1,427 CPs performed/supervised by 39 faculty emergency physicians, 55 (3.4%) on pediatric patients (Table 1). The average number of CPs monthly per physician was 3.85 (0.13 pediatric). Additionally, ultrasound for intravenous access, focused assessment with sonography for trauma (FAST), or cardiac exam was performed in 3,862 total resuscitations (178 pediatric).
Conclusions: In this study, faculty performed/supervised 6.2 times more total total CPs monthly than faculty at a similar volume pediatric-only trauma center. To the extent that these CP skills are transferrable from adults to children, emergency physicians in combined centers may have more opportunities for ongoing pediatric procedural skill retention and proficiency.
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